Benefit of a laparoscopic jejunostomy feeding catheter insertion to prevent bowel obstruction associated with feeding jejunostomy after esophagectomy

Abstract

The placement of a jejunostomy catheter during esophagectomy may cause postoperative bowel obstruction. The proximity of the jejunostomy site to the midline might be associated with bowel obstruction, and we have introduced laparoscopic jejunostomy (Lap-J) to reduce jejunostomy's left lateral gap. We evaluated 92 patients who underwent esophagectomy for esophageal cancer between February 2013 and August 2022 to clarify the benefits of Lap-J compared to other methods. The patients were classified into two groups according to the method of feeding catheter insertion: jejunostomy via small laparotomy (J group, n = 75), and laparoscopic jejunostomy (Lap-J group, n = 17). Surgery for bowel obstruction associated with the feeding jejunostomy catheter (BOFJ) was performed on 11 in the J group. Comparing the J and Lap-J groups, the distance between the jejunostomy and midline was significantly longer in the Lap-J group (50 mm vs. 102 mm; P < 0.001). Regarding surgery for BOFJ, the distance between the jejunostomy and midline was significantly shorter in the surgery group than in the non-surgery group (43 mm vs. 52 mm; P = 0.049). During esophagectomy, Lap-J can prevent BOFJ by placing the jejunostomy site at the left lateral position to the midline and reducing the left lateral gap of the jejunostomy.

Keywords: Esophageal cancer; Esophagectomy; Feeding catheter jejunostomy; Laparoscopic jejunostomy; Postoperative bowel obstruction.

Figure 1

A 9 Fr tube was inserted into the jejunum by puncturing the abdominal wall, and purse-string sutures were made from the outside using a Seldinger kit.

Figure 2

(a) After longitudinal fixation of the jejunum, an additional fixation was made at the oral side of the tube insertion point (arrow) to prevent bending. (b) Schema of a laparoscopic jejunostomy feeding catheter insertion.

Figure 3

The linear distance between the jejunostomy site and the midline of the abdomen was measured on the CT image.

Figure 4

Comparison of postoperative body weight change between the J and Lap-J groups.

Figure 5

Comparison of postoperative body weight change between with or without surgery for bowel obstruction associated with feeding jejunostomy catheter. The postoperative body weight rate in the BOFJ group was significantly decreased than in the non-BOFJ group at 6 and 12 months after the esophagectomy.